Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Ann Palliat Med. 2021 Sep;10(9):9372-9382. doi: 10.21037/apm-21-851. Epub 2021 Aug 16.
This investigation established a scoring scale for predicting the incidence of postoperative complications in patients after spinal tuberculosis debridement.
A total of 232 spinal tuberculosis patients who underwent debridement surgery between January 2012 to May 2020 were included in this retrospective study. The study cohort was divided into 2 groups according to the presence or absence of postoperative complications. The complications were defined as abnormal or impaired body function caused by surgical factors (such as nerve injury and internal fixation looseness) or other factors (such as chemotherapy and bed stay). Clinical characteristics include age, body mass index (BMI), diabetes mellitus, pulmonary tuberculosis, smoking history, preoperative serum albumin, preoperative C-reactive protein (CRP), Cobb angle correction, surgical approach, operation time, etc. operative blood loss was recorded and analyzed. The clinical characteristics of spinal tuberculosis patients who suffered postoperative complications were evaluated, and a scoring scale was established using logistic regression analysis. The performance of this scoring scale was prospectively validated.
Out of 232 patients, a total of 188 (81.03%) suffered postoperative complications after surgery. Multivariate binary logistic regression analysis showed that diabetes mellitus [adjusted odds ratio (OR) =1.110, P=0.046], pulmonary tuberculosis (adjusted OR =1.181, P=0.002), low preoperative serum albumin (adjusted OR =0.789, P=0.005), anterior surgical approach (adjusted OR =5.934, P=0.035), and long operation time (adjusted OR =1.019, P<0.01) were independent risk factors of postoperative complications after spinal tuberculosis debridement surgery. The above independent risk factors were assigned to establish a scoring scale for predicting postoperative complications, and receiver operating characteristic (ROC) analysis showed that the optimal cut-off value for the scoring scale was 4 points. The sensitivity and specificity of the scoring scale were 60.8% and 81.8%, respectively, based on the validation set.
Using the scoring scale, spinal tuberculosis patients with a score between 4 to 9 would be considered at high risk of postoperative complications, while patients with a score of 0 to 3 would likely be at low risk of developing postoperative complications.
本研究旨在建立一个评分量表，用于预测脊柱结核清创术后患者术后并发症的发生。
回顾性分析 2012 年 1 月至 2020 年 5 月期间接受清创手术的 232 例脊柱结核患者的临床资料。根据术后是否发生并发症，将研究对象分为两组。并发症定义为手术因素（如神经损伤和内固定松动）或其他因素（如化疗和卧床）引起的异常或受损的身体功能。临床特征包括年龄、体重指数（BMI）、糖尿病、肺结核、吸烟史、术前血清白蛋白、术前 C 反应蛋白（CRP）、Cobb 角矫正、手术入路、手术时间、术中出血量等。记录并分析临床资料。评估发生术后并发症的脊柱结核患者的临床特征，并采用 logistic 回归分析建立评分量表。前瞻性验证该评分量表的性能。
232 例患者中，188 例（81.03%）术后发生并发症。多因素二元逻辑回归分析显示，糖尿病[校正比值比（OR）=1.110，P=0.046]、肺结核（校正 OR=1.181，P=0.002）、术前血清白蛋白水平低（校正 OR=0.789，P=0.005）、前路手术（校正 OR=5.934，P=0.035）和手术时间长（校正 OR=1.019，P<0.01）是脊柱结核清创术后发生并发症的独立危险因素。根据上述独立危险因素建立预测术后并发症的评分量表，受试者工作特征（ROC）曲线分析显示，评分量表的最佳截断值为 4 分。验证集的评分量表的灵敏度和特异度分别为 60.8%和 81.8%。
应用评分量表，评分在 4 至 9 分的脊柱结核患者术后发生并发症的风险较高，而评分在 0 至 3 分的患者术后发生并发症的风险较低。
